Nasal Polyps

girl's nose. macro

Chad’s family has a history of allergies and asthma, as well as nasal polyps, so it came as no surprise that Chad suffered from them as well.  “Suffered” certainly is an appropriate word for anyone afflicted with nasal polyps. These are nodules that form in the cavities behind the nose and adjacent to the sinuses. They are little sacs that develop by themselves or in groups, and a single polyp can become as large as a grape. There isn’t much extra room in this area, and as these growths enlarge and multiply they prevent drainage and put pressure on the adjacent organs. The result is a feeling of heaviness and intense pressure, with painful, pounding headaches.

The formation of polyps appears to be the result of the body’s reaction to allergens or certain chemicals. Infections often follow, possibly because the drainage is blocked, so a course of antibiotics is generally given. Treatment usually begins with antihistamines. decongestants, and possibly allergy shots. In severe cases doctors prescribe steroids to help shrink the polyps, and then perform surgery to cut them out.

The Studies

The studies listed below are organized by date, with the most recent date first.  Some of the full texts will need a password because they are kept in a locked file to protect their copyright.  For educational purposes only, we are allowed to share the password with you if you write to us.

If you are trying to find a particular author, see the Index below which lists all the primary authors alphabetically with their publication dates.

Author Index
  1. Abrishami 1977
  2. Arai 1998
  3. Asero 2007
  4. Chudwin 1986
  5. Grzelewska-Rzymowska 1981
  6. Neuman 1978
  7. Pacor 1989
  8. Sakakibara 1995
  9. Schapowal 1995
  10. Spector 1979
  11. Wuthrich 1981
  12. Zheng 1999
Asero 2007: MSG and nasal polyps

Chronic rhinitis with nasal polyposis associated with sodium glutamate intolerance, Asero R1, Bottazzi G., International Archives of Allergy and Immunology. 2007;144(2):159-61.

The study reports a case of perennial rhinitis with bilateral polyposis. A careful diagnostic workup revealed that the disorder was caused by sodium glutamate intolerance. This is the first study showing an association between intolerance to food additives and nasal polyposis.

MedLine || Full Text || Get Password

Zheng 1999: Vitamin E may suppress nasal allergy

Effect of dietary vitamin E supplementation on murine nasal allergy. Zheng K, Adjei AA, Shinjo M, Shinjo S, Todoriki H, Ariizumi M, American Journal of the Medical Sciences 1999 Jul;318(1):49-54

“Although many studies have reported the effects of dietary vitamin E on the immune response, none so far has assessed its role in nasal allergy. … [this was an animal study] … The results indicate that higher doses of vitamin E supplementation may suppress nasal allergic responses.”
MedLine

Arai 1998: Study on sulfite & aspirin sensitivity in asthma

Food and food additives hypersensitivity in adult asthmatics. III. Adverse reaction to sulfites in adult asthmatics, Arai Y, Muto H, Sano Y, Ito K, Arerugi  1998 Nov;47(11):1163-7

“…Twenty adult asthmatic patients, who were non-steroid-dependent and without a suggestive history of sulfite sensitivity, underwent challenge with oral solution of metabisulfite. … 12 patients reacted to metabisulfite. They demonstrated airway obstruction 5 (41.7%), urticaria 4 (36.7%), skin manifestation 2 (16.7%) and nasal congestion 1 (8.3%). All patients who demonstrated airway obstruction, were sensitive to aspirin…”
MedLine

Schapowal 1995: Aspirin and rhinosinusitis, asthma, nasal polyps

Phenomenology, pathogenesis, diagnosis and treatment of aspirin-sensitive rhinosinusitis. Schapowal AG, Simon HU, Schmitz-Schumann M,  Acta Otorhinolaryngologica Belgica, 1995;49(3):235-50

“Aspirin-sensitive rhinosinusitis is a non-allergic, non-infectious perennial eosinophilic rhinitis starting in middle age and rarely seen in children. … There is an intolerance to aspirin and most other NSAID. An intolerance to tartrazine (Yellow 5), food additives, alcohol, narcotics and local anaesthetics can follow. Most aspirin-sensitive patients develop nasal polyps. Untreated, it can lead to asthma. The frequency of aspirin intolerance is 6.18% in patients with perennial rhinitis and 14.68% in patients with nasal polyps. … ”
MedLine

Sakakibara 1995: Aspirin-induced asthma & nasal polyps

Aspirin-induced asthma as an important type of bronchial asthma, Sakakibara H, Suetsugu S., Nihon Kyobu Shikkan Gakkai Zasshi. 1995 Dec;33 Suppl:106-15.

Aspirin-induced asthma (AIA) should be recognized as an important types of bronchial asthma for the following reasons.

  1.  The pathogenesis of AIA is specific. Inhibition of cyclooxygenase a (key enzyme for the production of prostanoids from arachidonic acid) by non-steroidal antiinflammatory drugs (NSAID) is an important trigger of asthma attacks.
  2. The frequency of AIA is not low. It is estimated to be 9.8% in adults with chronic asthma.
  3. Some clinical features of AIA are characteristic. Naso-sinus complications, such as rhinitis, chronic sinusitis, nasal polyposis, and anosmia, are commonly found in patients with AIA.
  4. Glucocorticoids with succinate ester, which are commonly used to treat asthma attacks, induce asthma symptoms or provoke severe asthma attacks in 70% to 80% of patients with AIA.
  5. Some patients with AIA are hypersensitive to some agents in addition to NSAID, e.g., tartrazine(15.1%), sodium benzoate (14.3%), and parabens (12.0%).
  6. Patients with latent AIA are in danger of having fatal or near-fatal asthma attacks if they take NSAID. We should educate patients to eliminate the risk posed by NSAID and other agents that may induce asthma attacks, and should enlighten doctors and pharmacists, who are not specialists in allergy or respiratory disease, about AIA.
  7. Asthma in these patients will be less severe if their condition is correctly diagnosed and they receive appropriate medical treatment.

MedLine (article in Japanese)

Pacor 1989: Double-blind study & diet for nasal polyps

Nasal polyps and food intolerance: is there any correlation, Pacor ML et al., Recenti Progressi in Medicina 1989 Jul-Aug;80(7-8):434-7

“In this study the Authors have evaluated the relationship between nasal polyposis and food using elimination diet and the double-blind challenge test. Of twenty-two patients examined, 16 (72.8%) completed the study. Six out of 16 subjects [37%] improved when on diet … Most patients had an alteration of immunological tests involving IgE or circulating immunocomplexes-mediated mechanism.”
MedLine (article in Italian)

Chudwin 1986: Case study of woman with asthma, nasal polyps & reactions to aspirin

Sensitivity to non-acetylated salicylates in a patient with asthma, nasal polyps, and rheumatoid arthritis. Chudwin DS, Strub M, Golden HE, Frey C, Richmond GW, Luskin AT,  Annals of Allergy 1986 Aug;57(2):133-4

” A woman experienced exacerbations of bronchial asthma after taking aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis. On oral challenges, she developed an urticarial reaction after tartrazine; urticarial and bronchospastic reactions after salicylsalicylic acid; and urticarial and bronchospastic reactions after choline magnesium trisalicylate. . . . The results of sensitivity studies of our patient indicates that such patients may also be sensitive to non-acetylated salicylates.
MedLine

Wuthrich 1981: Study on food additive reactions in 620 patients

Acetylsalicylic acid and food additive intolerance in urticaria, bronchial asthma and rhinopathy, Wuthrich B, Fabro L, Schweiz Med Wochenschr 1981 Sep 26;111(39):1445-50

“Adverse reactions (urticaria, angio-edema, bronchoconstriction, purpura) to Aspirin (ASS) and food-and-drug additives such as the yellow dye tartrazine and the preservative benzoate are observed all over the world… it is described as intolerance or pseudo-allergy and has been related to an imbalance of prostaglandin synthesis. Among 620 patients with urticaria, bronchial asthma or chronic rhinitis, oral provocation tests with ASS, tartrazine or benzoic acid revealed in 165 (26.6%) intolerance to ASS or additives…. More than two thirds of the intolerant patients were improved by an elimination diet and by the avoidance of “aspirin-like” drugs. More than one third of chronic urticaria patients became symptomfree. … Moreover, azo-dyes must no longer be used for colouring of drugs.”
MedLine  (article in German)

Grzelewska-Rzymowska 1981: Aspirin intolerance & asthma & nasal polyps

Asthma with aspirin intolerance. Clinical entity or coincidence of nonspecific bronchial hyperreactivity and aspirin intolerance. Grzelewska-Rzymowska I, Rozniecki J, Szmidt M, Kowalski ML, Allergol Immunopathol (Madr) 1981 Nov-Dec;9(6):533-8

“… Nasal and paranasal polyps were found in 77% of the group examined. The sequence of asthma, polyps and aspirin sensitivity has been analyzed. The authors conclude that aspirin – induced bronchoconstriction is the effect of the coincidence of two different phenomena in one subject, i. e. bronchial hyperreactivity and ASA – intolerance.”
MedLine

Spector 1979: Asthma reactions to salicylate, Yellow 5 & Tylenol

Aspirin and concomitant idiosyncrasies in adult asthmatic patients. Spector SL, Wangaard CH, Farr RS, Journal of Allergy & Clinical Immunology, 1979 Dec;64(6 Pt 1):500-6

” . . . A positive response to oral challenge, defined as a 20% fall in forced expiratory volume in 1 sec  (FEV1) from baseline for up to 4 hr, occurred in 44 of 230 patients with ASA (aspirin), 11 of 277 with tartrazine, 2 of 93 with sodium salicylate, and 2 of 69 with acetaminophen. No one had a positive response to tartrazine, sodium salicylate, or acetaminophen (Tylenol) who was not also positive to ASA. The dose of ASA causing a positive response was less than 5 grains in 95% of the patients. … 96% of those with ASA idiosyncrasy had sinusitis and 71% had nasal polyps. . . ”
MedLine

Neuman 1978: Yellow 5 & allergy; fibrinolytic pathway

The danger of “yellow dyes” (tartrazine) to allergic subjects, Neuman I, Elian R, Nahum H, Shaked P, Creter D. Clinical Allergy. 1978 Jan;8(1):65-8.

” Oral administration of 50 mg tartrazine to 122 patients with a variety of allergic disorders caused the following reactions: general weakness, heatwaves, palpitations, blurred vision, rhinorrhoea, feeling of suffocation, pruritus and urticaria. There was activation of the fibrinolytic pathway . . .”
MedLine || Full Text || Get Password

Abrishami 1977: Review of aspirin intolerance & asthma

Aspirin intolerance–a review. Abrishami MA, Thomas J, Ann Allergy 1977 Jul;39(1):28-37

” Association of bronchial asthma, nasal pathology and intolerance to aspirin is a unique syndrome. Aspirin-induced prolongation of bleeding time, and a tendency for diabetes, may exist with it. … Progression of asthma and nasal polyposis is not prevented by avoidance of aspirin. 4. Salicylates other than aspirin are well tolerated but cross-reactivity with other analgesics, and with tartrazine, may occur. …”
MedLine

The Diet Connection

Shortly after Chad (see article at left) had his fourth round of surgery, his son, Chad Jr., began preschool, and the family began using the Feingold diet for him.  To support Chad Jr, the whole family followed the diet, and all were happy to see the child respond so well.  They were surprised, however, at the response of Chad Senior.  After a few weeks on the Feingold Program, Chad told his wife, “You can’t believe the difference in how I feel.” The pressure, the headaches, nasal congestion, and of course, the polyps somehow seemed to be connected to the ingestion of certain food additives and salicylates.

Chad’s family weren’t the only ones to be surprised by his recovery. The doctor who had been caring for him, an eminent allergist and ENT specialist at the Medical College of Virginia, was astonished. “You were one of my worst patients,” he exclaimed, “what have you done?”  Chad replied, “Have you ever heard of Feingold?” Yes, the doctor had, but had never paid much attention to it. “I need a copy of this diet, ” he told Chad, “we might become famous over this!” Chad may or may not someday become a footnote in a medical text. For now,  just feeling good is enough.